Respiratory insufficiency in newborns with abdominal wall defects

Marc B. Hershenson, Robert T. Brouillette*, Linda Klemka, John D. Raffensperger, Andrew K. Poznanski, Carl E. Hunt

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

70 Scopus citations

Abstract

Respiratory failure in newborns with abdominal wall defects has been attributed to increased intra-abdominal pressure and elevation of the diaphragm after closure. Despite surgical techniques designed to minimize intraabdominal pressure, we have obseved prolonged respiratory insufficiency in several such infants. We reviewed the charts of 108 infants from 1975 to 1982 who had abdominal wall defects: 53 with gastroschisis, 29 with small omphaloceles, 22 with liver-containing or giant omphaloceles (GO), and four with cloacal exstrophy. Nine infants with GO (41%) had prolonged respiratory insufficiency and five died. Infants with GO required longer periods of oxygenation and ventilation (P<.001, ANOVA) than infants with other abdominal wall defects. Clinical observation suggested that infants with GO have a small, narrow thorax. We obtained detailed measurements from the chest radiographs of infants in all groups. After correction for birth weight, babies with GO had smaller chest widths (P<.001) and lung areas (P<.05) than infants with other abdominal wall defects. At autopsy, one newborn with GO was found to have severe pulmonary hypoplasia. Prolonged respiratory insufficiency in infants with GO may be explained by pulmonary hypoplasia and/or by a narrow chest deformity which limits lung expansion.

Original languageEnglish (US)
Pages (from-to)348-353
Number of pages6
JournalJournal of pediatric surgery
Volume20
Issue number4
DOIs
StatePublished - Aug 1985

Keywords

  • Omphalocele
  • abdominal wall defect
  • gastroschisis
  • respiratory failure

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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